期刊
ULTRASOUND IN OBSTETRICS & GYNECOLOGY
卷 32, 期 5, 页码 627-632出版社
WILEY
DOI: 10.1002/uog.6146
关键词
congenital diaphragmatic hernia; expectant management; liver quantification; magnetic resonance imaging
资金
- Prof. Ern. A. L. Baert, Siemens Medical Solutions [EMF-LSSMS1-113610]
- European Commission [QLG1 CT2002 01632]
- 6th Framework Programme (EuroSTEC) [LSHC-CT-2006-037409]
Objective To quantify the degree of intrathoracic liver herniation by magnetic resonance imaging (MRI) and evaluate its effect on postnatal survival in fetuses with isolated congenital diaphragmatic hernia (CDH). Methods Forty fetuses that were expectantly managed and that were delivered after 32 weeks' gestation were included in this study. On axial T2 weighted MR images the degree of intrathoracic liver herniation was measured by volumetry, using the xyphoid process and thoracic apex as landmarks. The ratio of the volume of the liver that was herniated into the thoracic cavity to the volume of the thoracic cavity was calculated (LiTR). All the fetuses also underwent lung volumetry, and the ratio of the observed/expected total fetal lung volume (o/e TFLV) was calculated. Regression analysis was used to investigate the effect on survival of side of occurrence of CDH, o/e TFLV, LiTR and gestational age at delivery. Receiver-operating characteristics (ROC) curves were constructed to examine the prediction of survival by o/e TFLV or LiTR alone and o/e TFLV and LiTR together. Results Univariate regression analysis demonstrated that significant predictors of survival were o/e TFLV and LiTR. Multiple regression analysis demonstrated that o/e TFLV and LiTR provided independent prediction of survival. The area under the ROC curve (AUC) for the prediction of postnatal survival from o/e TFLV alone was 0.846 (P < 0.001; SE = 0.062) and the AUC from LiTR alone was 0.875 (P = 0.001; SE = 0.072). The AUC for the prediction of postnatal survival from o/e TFLV and LiTR combined was 0.9.12 (P < 0.001; SE = 0.045), however it was not statistically significantly different from that of o/e TFLV alone. Conclusion In expectantly managed CDH fetuses, assessment of LiTR using MRI provided prediction of postnatal survival independently front o/e TFLV. Copyright (c) 2008 IS UOG. Published by John Wiley & Sons, Ltd.
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